Treating Prostate Cancer
Treatment Options for Men with Localized Prostate Cancer
Prostate Surgery (also called radical prostatectomy) is an operation to take out the prostate gland and the cancer inside the gland. The urethra (tube that carries urine) is surrounded by the prostate gland, so part of it has to be removed as well. The remaining urethra is reattached to the bladder. Other tissues around the prostate gland, like lymph nodes, may also be removed and checked for cancer.
Nerves that are needed for a man to get an erection are next to the prostate gland. These nerves can be damaged during surgery, which causes problems in keeping an erection. If the cancer has not spread near the nerves, they can be left alone and not taken out.
There is more research about prostate surgery than other active treatments. Men who have prostate surgery are more likely to survive their prostate cancer than men who follow watchful waiting. In general, men who have prostate surgery are in good health and are younger than men who use watchful waiting or other active treatments. The risks from prostate surgery increase as you get older. Up to 10 out of 100 men 65 years and older have heart and lung problems after surgery.
All prostate cancer treatments can cause side effects. The most commonside effects are sexual, urinary, and bowel problems.
Research tells us that using hormone treatment before prostate surgery does not work better than having prostate surgery without the hormone treatment. Hormone treatment used before surgery does not help men live longer and does not stop the cancer from coming back.
Radiation kills the cancer cells. The goal is to target the cancer and avoid hurting normal parts of the body. Radiation can be given in two ways – external beam radiation or brachytherapy. Sometimes the two kinds of radiation are used together.
External beam radiation uses radiation from a machine to target the prostate gland. This kind of radiation takes place in a hospital or clinic. The radiation is given a few minutes a day for about six to eight weeks.
Brachytherapy (also called radiation “seeding”) uses a needle to put small seeds of radiation into the cancer inside the prostate gland. This usually requires a trip to the hospital or clinic. The seeds inside the prostate gland slowly release radiation over time.
Research can’t tell us if men who have radiation live as long as men who use watchful waiting or have prostate surgery.
Testosterone is a hormone made by the body. It causes prostate cancer cells to grow. Hormone treatment lowers or blocks the body’s testosterone. This helps to slow or stop the growth of cancer cells.
Hormone treatments come in shots or pills. Most of the research about hormone medicines is on the following drugs: leuprolide (Lupron®, Viadur®, Eligard®), goserelin (Zoladex®), fl utamide (Eulexin®), and bicalutamide (Casodex®). Hormone medicines are often combined with prostate surgery or radiation. Hormone treatment can also be used by itself.
Most of the research is about combining hormone medicines with other types of prostate cancer treatments. There is less research about using hormone medicines on their own. Research can’t tell us if using other hormone treatments on their own can stop localized prostate cancer from spreading.
Men who combine hormone medicines with external beam radiation are more likely to survive their prostate cancer than men who get only radiation. Longer research studies are needed to see all the effects of the treatments.
Side Effects of Treatment
All prostate cancer treatments can cause side effects. The most common side effects are sexual, urinary, and bowel problems. Some of these problems happen soon after treatment and others develop over time. Talk to your doctor or nurse if you have any of these side effects. There may be a way to help.
Erectile dysfunction means not being able to keep an erection for intercourse. ED is the most common long-lasting side effect. It can happen with any treatment.
Urinary problems are another long-lasting side effect. This can mean leaking or dribbling urine. It can also mean sometimes not being able to hold your urine at all. Urinary problems are more common after surgery than with other treatments.
Bowel problems can also be a long-lasting side effect. This can mean sometimes having “bowel urgency” (needing to have a bowel movement right away and not being able to wait). Long-lasting bowel problems are more common after external beam radiation or hormone treatment than after prostate surgery or with watchful waiting.
Hormone treatments can have other side effects. They can cause hot fl ashes, breast swelling, and loss of sex drive. They can also cause tiredness, depression, and memory problems. Hormone treatments can weaken bones and raise the chance they will break.
Erection problems are common with all treatments. Bowel problems are more common with external beam radiation. Urinary problems are more common with prostate surgery.
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Source: U.S. Department of Health & Human Services Agency for Healthcare Research and Quality
This article was originally published in Coping® with Cancer magazine, January/February 2009.
Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.